Jury still out on public performance reporting

Associate Professor Christine Jorm and Professor Michael Frommer from the Sydney Medical School wrote that while it was difficult to determine which types of public reporting to use, public scrutiny ensured accountability, encouraged health providers to improve services and gave consumers information on which to base their expectations and make decisions.

The absence of public reporting generated suspicion and cynicism among both clinicians and the public, they said, noting that the Australian Medical Association submission on the proposed National Health Performance Authority advocated stronger investigative and disciplinary powers for the new watchdog and a mandatory requirement to release reports.

“Review, comparison and criticism are essential components of professional practice. Honesty is a central value of professionalism, and the wellbeing of patients must take precedence over professional self-interest. Public performance reporting promotes strong adherence to these values and therefore should be at the core of good health system governance,” Assoc Prof Jorm said.

But in an opposing view, Professor Jeffrey Braithwaite of the Australian Institute of Health Innovation at the University of NSW and Professor Russell Mannion of the University of Birmingham’s Health Services Management Centre argue that the benefits of public performance reporting have not been shown to outweigh the costs.

“Where is the Australian business case, or the international cost-benefit analysis, applied to Australia that compels us to not only accept but insist on its introduction? Health care is renowned for ‘hoovering up’ data, which get stuck in the system. Will a national performance measurement initiative fare any better? We prefer to maintain a healthy scepticism,” they wrote.

The enormous complexity of health care meant that it was almost impossible to determine what should be measured, how it should be measured and from whose perspective, and differences in the way data were collected across jurisdictions made comparison difficult.

“All in all, performance measurement systems often have little impact on changing behaviour or improving performance. As that is the point of them, and until the fundamental problems we describe are sorted out, we respond with a resounding no to the proposition that health care data should be publicly reported,” Prof Braithwaite said.

The Medical Journal of Australia is a publication of the Australian Medical Association.

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The statements or opinions that are expressed in the MJA reflect the views of the authors and do not represent the official policy of the AMA unless that is so stated.

CONTACT:                 Assoc Prof Christine Jorm                 0416 149 477

                                Prof Jeffrey Braithwaite                    0414 812 579